Abstract
Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (ARBs) are commonly used in patients with CKD. This is based on large RCT trials and mount of epidermiology data. Even so, their value for patients with severe CKD (estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2) is unknown. Concerns about the decline in renal function with the use of ACEi/ARBs, especially in patients with severe CKD, lead to expectations that stop using ACEi/ARBs in this patient population may delay the event with the resultant delay in progressing to renal replacement therapy faced with concerns about the risk of flare-ups of cardiovascular events. In fact, there are no studies evaluating the benefit of ACEi/ARB in reducing cardiovascular risk in non-dialysis end staged chronic kidney disease. Several studies, such as the STOP-ACEi trial, have been conducted with the aim of addressing knowledge gaps as well as examining the balance between the benefits of delaying dialysis and cardiovascular risk in severe CKD patient..